Myths: COVID-19
13 Coronavirus myths
busted by science Here at Live Science, we've compiled a list of the most pervasive myths about the novel coronavirus SARS-CoV-2 and COVID-19, the disease it causes, and explained why these rumors are misleading, or just plain wrong. Myth: Face masks can protect you from the virus Standard surgical masks cannot protect you from SARS-CoV-2, as they are not designed to block out viral particles and do not lay flush to the face, Live Science previously reported. That said, surgical masks can help prevent infected people from spreading the virus further by blocking any respiratory droplets that could be expelled from their mouths. Within health care facilities, special respirators called "N95 respirators" have been shown to greatly reduce the spread of the virus among medical staff. People require training to properly fit N95 respirators around their noses, cheeks and chins to ensure that no air can sneak around the edges of the mask; and wearers must also learn to check the equipment for damage after each use. Myth: You're waaaay less likely to get this than the flu Not necessarily. To estimate how easily a virus spreads, scientists calculate its "basic reproduction number," or R0 (pronounced R-nought). R0 predicts the number of people who can catch a given bug from a single infected person, Live Science previously reported. Currently, the R0 for SARS-CoV-2, the virus that causes the disease COVID-19, is estimated at about 2.2, meaning a single infected person will infect about 2.2 others, on average. By comparison, the flu has an R0 of 1.3. Perhaps, most importantly, while no vaccine exists to prevent COVID-19, the seasonal flu vaccine prevents influenza relatively well, even when its formulation doesn't perfectly match the circulating viral strains. Myth: The virus is just a mutated form of the common cold No, it's not. Coronavirus is a large family of viruses that includes many different diseases. SARS-CoV-2 does share similarities with other coronaviruses, four of which can cause the common cold. All five viruses have spiky projections on their surfaces and utilize so-called spike proteins to infect host cells. However, the four cold coronaviruses — named 229E, NL63, OC43 and HKU1 — all utilize humans as their primary hosts. SARS-CoV-2 shares about 90% of its genetic material with coronaviruses that infect bats, which suggests that the virus originated in bats and later hopped to humans. Evidence suggests that the virus passed through an intermediate animal before infecting humans. Similarly, the SARS virus jumped from bats to civets (small, nocturnal mammals) on its way into people, whereas MERS infected camels before spreading to humans. Myth: The virus was probably made in a lab No evidence suggests that the virus is man-made. SARS-CoV-2 closely resembles two other coronaviruses that have triggered outbreaks in recent decades, SARS-CoV and MERS-CoV, and all three viruses seem to have originated in bats. In short, the characteristics of SARS-CoV-2 fall in line with what we know about other naturally occurring coronaviruses that made the jump from animals to people. Myth: Getting COVID-19 is a death sentence That's not true. About 81% of people who are infected with the coronavirus have mild cases of COVID-19, according to a study published Feb. 18 by the Chinese Center for Disease Control and Prevention. About 13.8% report severe illness, meaning they have shortness of breath, or require supplemental oxygen, and about 4.7% are critical, meaning they face respiratory failure, multi-organ failure or septic shock. The data thus far suggests that only around 2.3% of people infected with COVID-19 die from the virus. People who are older or have underlying health conditions seem to be most at risk of having severe disease or complications. While there's no need to panic, people should take steps to prepare and protect themselves and others from the new coronavirus. Myth: Pets can spread the new coronavirus Probably not to humans. One dog in China contracted a "low-level infection" from its owner, who has a confirmed case of COVID-19, meaning dogs may be vulnerable to picking up the virus from people, according to The South China Morning Post. The infected Pomeranian has not fallen ill or shown symptoms of disease, and no evidence suggests that the animal could infect humans. Several dogs and cats tested positive for a similar virus, SARS-CoV, during an outbreak in 2003, animal health expert Vanessa Barrs of City University told the Post. "Previous experience with SARS suggests that cats and dogs will not become sick or transmit the virus to humans," she said. "Importantly, there was no evidence of viral transmission from pet dogs or cats to humans." Just in case, the Centers for Disease Control and Prevention (CDC) recommends that people with COVID-19 have someone else walk and care for their companion animals while they are sick. And people should always wash their hands after snuggling with animals anyway, as companion pets can spread other diseases to people, according to the CDC. Myth: Lockdowns or school closures won't happen in the US There's no guarantee, but school closures are a common tool that public health officials use to slow or halt the spread of contagious diseases. For instance, during the swine flu pandemic of 2009, 1,300 schools in the U.S. closed to reduce the spread of the disease, according to a 2017 study of the Journal of Health Politics, Policy and Law. At the time, CDC guidance recommended that schools close for between 7 and 14 days, according to the study. While the coronavirus is a different disease, with a different incubation period, transmissibility and symptom severity, it's likely that at least some school closures will occur. If we later learn that children are not the primary vectors for disease, that strategy may change, Dr. Amesh Adalja, an infectious disease expert at the Johns Hopkins Center for Health Security in Baltimore, previously told Live Science. Either way, you should prepare for the possibility of school closures and figure out backup care if needed. Lockdowns, quarantines and isolation are also a possibility. Under section 361 of the Public Health Service Act (42 U.S. Code § 264), the federal government is allowed to take such actions to quell the spread of disease from either outside the country or between states. State and local governments may also have similar authority. Myth: Kids can't catch the coronavirus Children can definitely catch COVID-19, though initial reports suggested fewer cases in children compared with adults. For example, a Chinese study from Hubei province released in February found that of more than 44,000 cases of COVID-19, about only 2.2% involved children under age 19. However, more recent studies suggest children are as likely as adults to become infected. In a study reported March 5, researchers analyzed data from more than 1,500 people in Shenzhen, and found that children potentially exposed to the virus were just as likely to become infected as adults were, according to Nature News. Regardless of age, about 7% to 8% of contacts of COVID-19 cases later tested positive for the virus. Still, when children become infected, they seem less likely to develop severe disease, Live Science previously reported. Myth: If you have coronavirus, "you'll know" No, you won't. COVID-19 causes a wide range of symptoms, many of which appear in other respiratory illnesses such as the flu and the common cold. Specifically, common symptoms of COVID-19 include fever, cough and difficulty breathing, and rarer symptoms include dizziness, nausea, vomiting and a runny nose. In severe cases, the disease can progress into a serious pneumonia-like illness — but early on, infected people may show no symptoms at all. U.S. health officials have now advised the American public to prepare for an epidemic, meaning those who have not traveled to affected countries or made contact with people who recently traveled may begin catching the virus. As the outbreak progresses in the U.S., state and local health departments should provide updates about when and where the virus has spread. If you live in an affected region and begin experiencing high fever, weakness, lethargy or shortness of breath, or or have underlying conditions and milder symptoms of the disease, you should seek medical attention at the nearest hospital, experts told Live Science. From there, you may be tested for the virus, though as of yet, the CDC has not made the available diagnostic exam widely available. Myth: The coronavirus is less deadly than the flu So far, it appears the coronavirus is more deadly than the flu. However, there's still a lot of uncertainty around the mortality rate of the virus. The annual flu typically has a mortality rate of around 0.1% in the U.S. So far, there's a 0.05% mortality rate among those who caught the flu virus in the U.S. this year, according to the CDC. In comparison, recent data suggests that COVID-19 has a mortality rate more than 20 times higher, of around 2.3%, according to a study published Feb. 18 by the China CDC Weekly. The death rate varied by different factors such as location and an individual's age, according to a previous Live Science report. But these numbers are continuously evolving and may not represent the actual mortality rate. It's not clear if the case counts in China are accurately documented, especially since they shifted the way they defined cases midway through, according to STAT News. There could be many mild or asymptomatic cases that weren't counted in the total sample size, they wrote. Vitamin C supplements will stop you from catching COVID-19 Researchers have yet to find any evidence that vitamin C supplements can render people immune to COVID-19 infection. In fact, for most people, taking extra vitamin C does not even ward off the common cold, though it may shorten the duration of a cold if you catch one. That said, vitamin C serves essential roles in the human body and supports normal immune function. As an antioxidant, the vitamin neutralizes charged particles called free radicals that can damage tissues in the body. It also helps the body synthesize hormones, build collagen and seal off vulnerable connective tissue against pathogens. So yes, vitamin C should absolutely be included in your daily diet if you want to maintain a healthy immune system. But megadosing on supplements is unlikely to lower your risk of catching COVID-19, and may at most give you a "modest" advantage against the virus, should you become infected. No evidence suggests that other so-called immune-boosting supplements — such as zinc, green tea or echinacea — help to prevent COVID-19, either. Be wary of products being advertised as treatments or cures for the new coronavirus. Since the COVID-19 outbreak began in the United States, the U.S. Food and Drug Administration (FDA) and the Federal Trade Commission (FTC) have already issued warning letters to seven companies for selling fraudulent products that promise to cure, treat or prevent the viral infection. Myth: It's not safe to receive a package from China It is safe to receive letters or packages from China, according to the World Health Organization. Previous research has found that coronaviruses don't survive long on objects such as letters and packages. Based on what we know about similar coronaviruses such as MERS-CoV and SARS-CoV, experts think this new coronavirus likely survives poorly on surfaces. A past study found that these related coronaviruses can stay on surfaces such as metal, glass or plastic for as long as nine days, according to a study published Feb. 6 in The Journal of Hospital Infection. But the surfaces present in packaging are not ideal for the virus to survive. For a virus to remain viable, it needs a combination of specific environmental conditions such as temperature, lack of UV exposure and humidity — a combination you won't get in shipping packages, according to Dr. Amesh A. Adalja, Senior Scholar, Johns Hopkins Center for Health Security, who spoke with Live Science's sister site Tom's Hardware. And so "there is likely very low risk of spread from products or packaging that are shipped over a period of days or weeks at ambient temperatures," according to the CDC. "Currently, there is no evidence to support transmission of COVID-19 associated with imported goods, and there have not been any cases of COVID-19 in the United States associated with imported goods." Rather, the coronavirus is thought to be most commonly spread through respiratory droplets. Myth: You can get the coronavirus if you eat at Chinese restaurants in the US No, you can't. By that logic, you'd
also have to avoid Italian, Korean, Japanese and Iranian
restaurants, given that those countries have also been
facing an outbreak. The new coronavirus doesn't just affect
people of Chinese descent. A viral text
warns taking Advil could make COVID-19 symptoms worse, but
experts say it’s unfounded The problem is: there isn’t any evidence that it’s true. There hasn’t been enough research on ibuprofen in COVID-19 patients to determine whether it is actually harmful. An alternative is acetaminophen, which is marketed by Johnson & Johnson as Tylenol. But not everyone can take it because it can make some liver conditions worse. “Vast majority of people who died had ibuprofen / Advil in their system so do not take it!!” the message reads. “Those who recovered did not take ibuprofen so if you have symptoms, take Paracetamol only!!! Looks like this virus thrives on ibuprofen so don’t do it and tell everyone you can!!!” The telltale signs of misinformation are everywhere in the Advil rumor. Many of the messages claim to be coming from someone’s friend or sister who is a nurse at New York University. She seems to have firsthand information about the mysterious Vienna laboratory. The vague attribution makes the information difficult to track. The message also ends with a plea: tell everyone you know! Pass it on! This type of urgent request exploits the need for concrete information and the desire we have to protect one another. Like most effective misinformation, the message mixes bits of truth with outright lies. For instance, France’s health minister tweeted out a warning that “taking anti-inflammatory drugs (ibuprofen, cortisone, ...) could be a factor in worsening the infection,” wrote Stephanie M. Lee from BuzzFeed. The warning echoed a letter written to The Lancet, a medical journal, on March 11th. There, researchers claimed that taking certain drugs — including ibuprofen — could make people more susceptible to the virus. But experts refuted these claims. Michele Barry, director of the Center for Innovation in Global Health at Stanford University, told The New York Times that there was simply no data to back them up. Garret FitzGerald from the University of Pennsylvania’s Perelman School of Medicine, told the Times, “It’s all anecdote, and fake news off the anecdotes. That’s the world we are living in.” The rumor gained enough traction, however, that GlaxoSmithKline issued a statement refuting the claims. The statement now pops up if you go to the website for Advil. “We understand the use of steroids and non-steroidal anti-inflammatory (NSAIDs) products, including ibuprofen, for the alleviation of COVID-19 symptoms has come into question,” the statement reads. “As a leader in the OTC pain category, GSK Consumer Healthcare is not aware of any scientific evidence that directly links worse outcomes in patients suffering from COVID-19 infection with the use of ibuprofen or other anti-inflammatories.” The World Health Organization (WHO)
told The Verge that it is not aware of any studies showing
ibuprofen could be dangerous for COVID-19 patients. “We
are consulting with physicians treating COVID-19 patients
and are not aware of reports of any negative effects of
ibuprofen, beyond the usual known side effects that limit
its use in certain populations,” a WHO spokesperson
said in an emailed statement. “Based on currently
available information, WHO does not recommend against the
use of ibuprofen.” Should you take
ibuprofen if you have COVID-19? When French Health Minister Olivier Véran warned COVID-19 patients to avoid taking anti-inflammatory drugs such as ibuprofen or cortisone, the statement ignited a discussion among experts and a slew of questions from the general public. If you have a fever, take paracetamol, the health minister said (Paracetamol and Tylenol are both brand names for a drug called acetaminophen). But do such anti-inflammatory drugs actually exacerbate COVID-19? Experts say there's not enough data to say. “There is currently no scientific evidence establishing a link between ibuprofen and worsening of COVID-19," the European Medicines Agency (EMA) wrote in a statement on March 18. "EMA is monitoring the situation closely and will review any new information that becomes available on this issue in the context of the pandemic." The health minister's warning was based on a recent letter published in the journal The Lancet that suggested such anti-inflammatory drugs boost the body's production of an enzyme that sits on the cell's surface, known as ACE2. The coronavirus hijacks these ACE2 receptors to enter human cells.The authors hypothesized that drugs that spur the body to produce more of this enzyme would allow the virus to infect more cells, which in turn could increase the risk of developing "severe and fatal" COVID-19. "The only problem is they offer no proof that this actually occurs," Angela Rasmussen, a virologist at Columbia University in New York, wrote on Twitter. Should you take ibuprofen if you have COVID-19? More of that enzyme, called ACE2, doesn't necessarily mean more infected cells, as viruses require other proteins in the human cell to replicate, she wrote. What's more, even if more cells are infected, that doesn't mean more copies of the virus will be created. And even if these cells produce more viral copies, that doesn't necessarily mean more-severe disease. The severity of the disease can depend on other factors, such as the patient's genetics, environment and general health, Rasmussen wrote. World Health Organization (WHO) @WHO Q: Could #ibuprofen worsen disease for people with #COVID19? A: Based on currently available information, WHO does not recommend against the use of of ibuprofen. Cause or association? So, should you toss out your Advil if you come down with COVID-19? "I would not change recommendations based on this yet," said Dr. Amesh Adalja, an infectious disease expert at the Johns Hopkins Center for Health Security in Baltimore. "I think we need to learn more about what the effect is and if it's a true effect or [just an] association." For example, it could be that people with higher fevers, and thus more-severe disease, are taking these medications more frequently because they have a greater need for fever reducers, he said. In other words, they could have more-severe disease in the first place. It's also known that anti-inflammatory drugs can exacerbate problems with kidney function in those who have preexisting problems, Adalja told Live Science. Anti-inflammatories and acetaminophen medications work through different mechanisms in the brain: Acetaminophen targets a brain region that regulates body temperature, whereas anti-inflammatories decrease the production of inflammatory markers, Adalja said. Both effectively reduce fevers. However, in general, a fever is a "protective response," he added. At such temperatures, the immune system may work better and invading microbes may not function as well, he added. So for some illnesses, letting a low fever, around 101 degrees Fahrenheit (38.3 degrees Celsius) or so, run its course may be best for most young and healthy people. For those with underlying medical problems, fevers can be more dangerous, he said. Another reason some experts are concerned about the use of anti-inflammatories is that they may dampen the immune system's response, according to The Guardian. By that logic, "anti-inflammatory agents reduce the inflammatory response, which could be beneficial in the early stages of the infection," said Steve Morse, a professor of epidemiology at Columbia University. But inflammation is good only up to a point. "Later on, inflammation becomes a serious problem in patients with pneumonia or other severe disease, and exacerbates the damage," Morse told Live Science. In China and elsewhere, health care professionals have tried treating patients with steroids to combat such damage caused by the immune response. "It wasn't clear if it helped, and most people think it didn't," Morse said. In any case, "you wouldn't want a vigorous inflammatory response in the later stages … so perhaps it's all in the timing," he added. Here in the U.S., the guidelines haven't changed. "I have not seen any firm data to indicate there's a problem or to prove there's not a problem," Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said during a news conference yesterday (March 18). Aspirin, another anti-inflammatory drug, can increase children's risk of developing Reye's syndrome, a rare disease that can cause brain and liver damage. "I think somebody made the leap from that" to say that all anti-inflammatories or nonsteroidals are "the same thing," Fauci said. In any case, "if you really want to just bring the temperature down," Tylenol every 6 hours is the way to go, Fauci added. "Source:
www.livescience.com/ibuprofen-coronavirus-symptoms.html Medication in
the Time of COVID-19: Listen to the Experts COVID-19, the new disease that has put the world on edge, has spread around the globe with shocking rapidity. Guesses and half-baked hypotheses of how to treat it have spread almost as fast. Pharmacologists and frontline doctors began exchanging messages weeks ago online: ibuprofen might be dangerous for people with COVID-19. Then the medical journal Lancet Respiratory Medicine published a paper on March 11 hypothesizing that patients with diabetes and hypertension could be at greater risk of COVID-19 infection due to the medicines they take. Three days later, the French health minister tweeted that taking anti-inflammatory medications such as ibuprofen could worsen cases of the viral illness. And now, due to vague reports that certain antimalarial medicines might be effective against COVID-19, an Arizona man accidentally killed himself using antiparasite aquarium cleaner to treat the virus at home. There are valid scientific reasons why ibuprofen, ACE2 inhibitors taken for hypertension, and antimalarials might all have effects on COVID-19 infections. But there are grave dangers in adjusting or self-prescribing medications without the advice of a doctor or pharmacist. We asked two UConn pharmacologists and a clinical pharmacist, an infectious disease specialist at UConn Health, and a Poison Control doctor for their best advice. Read it, educate yourself, and above all be safe: consult your doctor or pharmacist before adjusting your own medications. (And please—never, ever drink aquarium cleaner.) Why all the noise about ibuprofen and COVID-19? UConn professor of pharmacology and toxicology Xiaobo Zhong: Preliminary messages coming out of Europe indicate that ibuprofen (a common brand name is Advil) increases the rate of multiplication of the COVID19 virus. A study published in The Lancet indicates ibuprofen can increase the amount of ACE2 that cells make. ACE2 is a membrane surface protein that acts like a doorknob for COVID-19, allowing it to enter human cells and hijack them to make copies of itself. We don’t know if other non-steroidal anti-inflammatory drugs such as aspirin also increase ACE2. Is this really a big deal? How worried should I be about taking ibuprofen if I have a fever and think I might have COVID-19? UConn department head and professor of toxicology José Manautou: Fever is a normal compensating mechanism in our bodies to help us fight infections. It’s not necessarily bad to have a fever. However, uncontrolled fevers with very high temperatures can lead to mental dysfunction, convulsions, and even coma. We do not yet know how worried to be about ibuprofen. You can take acetaminophen (common brand names include Tylenol) instead. It’s good for fever and pain. But do not take higher than the recommended dose! If you take too much acetaminophen, you can damage your liver. Acetaminophen is the number one cause of acute liver failure in the US. If risk factors are present—if you’ve been drinking alcohol, or are malnourished from not eating because you are sick—toxicity can happen at doses lower than what is normally considered to be toxic, in some cases at doses within the therapeutic margin. If the recommended dose is not sufficient and you still have a fever, do not take more! Consult your pharmacist or physician. What if I want more detailed information on treatment options? Manautou: UConn pharmacy faculty have put together a detailed information sheet aimed at healthcare professionals. Is there anything else I need to know about acetaminophen and COVID-19? Zhong: Remdesivir, which is an antiviral drug just approved by the Food and Drug Administration to treat COVID-19, might cause liver inflammation in some patients. The evidence for this is from Ebola patients. It’s possible that combining acetaminophen with remdesivir could make patients even more sensitive to liver damage. We don’t have any indication that this will be an interaction, but it’s possible. Gilead, the company that makes remdesivir, has agreed to give us some of the drug to start a study on this. What if I have diabetes or high blood pressure? UConn Department Head of Pharmacy Practice Michael White: People with diabetes or high blood pressure are likely to be prescribed ACE inhibitors (lisinopril, enalapril, ramipril) and Angiotensin Receptor Blockers (ARBs; losartan, valsartan, candesartan). They’re the fourth and eleventh most used drug classes in the United States, with approximately 250 million prescriptions filled annually. Both ACE inhibitors and ARBs increase the amount of ACE2 in the body. The COVID-19 virus uses ACE2 to get into the body’s cells and multiply, so more ACE2 should mean more infection—theoretically. But it’s not that simple. For patients with high blood pressure, chronic kidney disease, a past heart attack, or heart failure, suddenly stopping ACE inhibitors and ARBS can damage their hearts and kidneys and even hasten death. And there’s a second reason not to stop taking the medicines. They might actually protect patients with COVID-19. ACE2 helps maintain the proper balance of sodium and potassium in the body. In people with heart disease and diabetes, that balance can be upset, and cause heart arrhythmias and kidney injury. In severe cases, COVID19 can cause similar problems to the body, and people with heart disease and diabetes are more at risk. The bottom line is that while ACE2 is needed for the virus to enter cells, having a slight decrease in ACE2 because patients are no longer on ACE inhibitors or ARBs is unlikely to prevent infections. How should I take care of myself or another member of my household with mild COVID-19? UConn Health infectious disease specialist David Banach: The main focus is the management of their symptoms with supportive care (hydration, nutrition, etc.) while self-isolated from others within the home. The CDC has a nice patient education sheet addressing this. Frequent hand-washing, and cleaning any potential shared items/surfaces that others may come in contact with is also critical. If you have any new symptoms or worsening of your initial symptoms (fever, cough), you should call your healthcare provider to determine next steps. If symptoms are worsening over a relatively short period of time, this may warrant going to the emergency department. It’s essential that individuals with risk factors for severe disease, such as older age, or co-existent medical conditions, have a low threshold to seek care. We recently learned of a death in another state due to someone trying using a toxic substance (aquarium cleaner) in an attempt to treat coronavirus. What can you tell us about that? Dr. Suzanne Doyon, UConn Health assistant professor of emergency medicine: We’ve seen in the news that chloroquine is being studied for the management of coronavirus illness, but what we have seen from a poison control center perspective is people taking matters into their own hands and seeking chloroquine alternatives – for example chloroquine phosphate in aquarium products. The Banner Poison and Drug Information Center in Arizona reported that a person died this weekend after ingesting a chloroquine phosphate aquarium product. This person was using it as a substitute for pharmaceutical-grade chloroquine, and that is completely outside of what we would recommend. What are the dangers associated with chloroquine? Doyon: Chloroquine has been used for the management of malaria for decades. Both chloroquine and hydroxychloroquine have some usefulness in the management of certain inflammatory diseases such as rheumatoid arthritis and lupus. It must be emphasized that chloroquine is a very toxic medication, and when you ingest too much of it you will develop symptoms including loss of hearing, loss of vision, and potentially cardiac arrhythmias. Chloroquine is a prescription product and should always be taken under medical supervision. Zhong: A previous study has shown chloroquine can exacerbate acetaminophen-induced liver injury in mice due to its ability to inhibit autophagy and mitochondria function. Whether hydroxylchloroquine can make liver damage worse in combinational use with acetaminophen is unknown. What are the up-limited doses of acetaminophen and hydroxylchloroquine for COVID-19 patients? Unknown. The knowledge is so urgently important for tens thousands of people who are suffering COVID-19 in the US and needs to be addressed quickly. White: People should not start buying drugs like hydroxychloroquine over the internet from non-registered pharmacies (or ones that say they are from Canada) because they are likely counterfeit, and not only will they not help you, they could have harmful chemicals in them that could hurt you as well. In August 2017, the National Association of Boards of Pharmacy (NABP) issued an update to their ongoing analysis of online pharmacies. NABP found that 95.8% of the 11,688 internet pharmacies they analyzed do not comply with US federal or state laws. Overall, 74.1% of the 108 internet sites stating they are from Canada are not sourcing drugs approved for use by Canadian citizens. Many of these drugs are counterfeits and have little or no active ingredients, some have other harmful drugs or chemicals in them, and others have heavy metal contamination. What other potential remedies are worrisome? Doyon: We’re hearing clinical trials are testing the combination of chloroquine and azithromycin (otherwise known as Zithromax or Z-Pak). The combination of the two has us particularly worried because of the high risk for heart rhythm disturbances, which may be very difficult to treat. Hopefully the combination of these drugs is administered by health care providers who are monitoring for these risks and are addressing these arrhythmias should they occur. But I can’t emphasize enough how risky the combination of the two medications could be in an unsupervised setting. Has the Connecticut Poison Control Center been getting more calls about ingesting of hand sanitizer in recent weeks? Doyon: The Connecticut Poison Control Center has found that hand sanitizer ingestions in children are about double what they were last year at the same time. That probably stems from the fact that there’s a lot more hand sanitizer in the household and environment. I want to stress that the ingredients in hand sanitizer can include ethanol, which is basically regular alcohol, or isopropanol, which is basically regular rubbing alcohol, both of which can cause a lot of problems in children. Especially alcohol, it can cause electrolyte abnormalities and serious toxicity in children. What we’d like people to understand is, when a child ingests this, it is best to call the poison control center, let us do a dose calculation and assessment, and make recommendations. A taste, lick, or drop can usually be safely managed at home. A teaspoon/tablespoon, depending on the size of the child, might mean a trip to the emergency department. The Connecticut Poison Control Center at UConn Health is answering calls 24/7. Our nurses and pharmacists are well trained in all types of poisonings. About 75% of pediatric exposures are treated at home, saving parents visits to the emergency department and really helping limit that social interaction that occurs when one visits the hospital. When an ingestion or exposure has occurred, we urge parents, and all Connecticut residents, to call the poison control center first and foremost, so we can help determine what the best next step is. NOTE: As of March 23, there have
been no chloroquine-related calls to the Connecticut Poison
Control Center since the COVID-19 outbreak. Misguided
drug advice for COVID-19 As pandemic coronavirus disease 2019 (COVID-19) continues to accelerate, the French Health Minister, Olivier Véran, has confused matters by claiming on Twitter that anti-inflammatory drugs like ibuprofen or cortisone could aggravate the infection (1). However, scientific evidence does not indicate that nonsteroidal anti-inflammatory drug (NSAID) consumption puts patients who otherwise might have mild or asymptomatic infection by severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2)—the virus that causes COVID-19—at risk of more severe disease. People taking NSAIDs for other reasons should not stop doing so for fear of increasing their COVID-19 risk. NSAIDs work by suppressing prostaglandin synthases 1 and 2, colloquially known as COX-1 and COX-2. These enzymes produce prostaglandins (PGs), lipids that can trigger pain and fever. COX-2 produces most of the PGs relevant to pain and inflammation. NSAIDs selective for inhibiting COX-2 include celecoxib and diclofenac; ibuprofen is an NSAID that blocks both COXs. Minister Véran advised people to take paracetamol (acetaminophen) instead to treat a fever (1), but this guidance only adds to the confusion given that acetaminophen is also an NSAID (2). We don't know with certainty whether NSAIDs could lead to more severe COVID-19 symptoms because PGs, such as PGE2, PGD2, and prostacyclin (PGI2) can both promote and restrain inflammation. For example, the infection of certain immune cells (microglia) with a related coronavirus (not the one that causes COVID-19) activates a proinflammatory response (the inflammasome) to combat the pathogen; however, PGD2 increases the expression of PYDC3, a putative inflammasome inhibitor, in certain immune cells in mice (3). The SARS coronavirus responsible for the 2003 outbreak directly binds to the COX-2 promotor and increases its expression (4), boosting PG production capacity, and there is also evidence that PGE2 inhibits SARS coronavirus replication (5). Indomethacin, an NSAID, blocks coronavirus RNA synthesis but independently of COX inhibition (6). By contrast, COX-2–dependent PGE2 attenuates the chronic antiviral lymphocyte response of unresolved viral infection (7). Based on these findings, if we see a clinical signal, we can rationalize it, but therein lies the challenge. Many clinical anecdotes remain stalled in biological plausibility. The prospect of a rapid increase in COVID-19 cases prompts us to seek covariates of disease severity, from the consumption of certain drugs before infection, to human genetic variants (8), to demographic factors such as sex and environmental exposures. In the case of NSAIDs, commonly acquired without prescription, such determination requires documentation of drug exposure and evidence of PG suppression. Considering all of this, should patients with clinically complicated SARS-CoV-2 infections be administered NSAIDs as a treatment? No. There is no evidence of benefit. If such a patient were also to have poor kidney function, maintenance of renal blood flow becomes critically dependent on vasodilator PGs, such as PGE2 and PGI2 (9). Such a situation might also predispose the patient to the gastrointestinal and cardiovascular complications of NSAIDs. However, until we have robust evidence, patients in chronic pain should continue to take their NSAIDs rather than turn to opiates. Given that the elderly appear to comprise the predominant at-risk group for severe COVID-19 at this time, an association between NSAIDs and the disease may merely reflect reverse causality—that is, infection makes you more susceptible to adverse effects of NSAIDs on the infection. A similar rationale should be applied to evidence that coronaviruses use the angiotensin converting enzyme (ACE) 2 as a receptor for cellular entry (10). There has been speculation, but no clinical evidence, that consumption of ACE inhibitors might worsen the consequences of infection (11). Patients on ACE inhibitors should continue to take them rather than risk complications, such as stroke. References and Notes K. Willsher, Anti-inflammatories may aggravate Covid-19, France advises, The Guardian (2020).Google Scholar F. Catella-Lawson et al., N. Engl. J. Med. 345, 1809 (2001).CrossRefPubMedWeb of ScienceGoogle Scholar R. Vijay et al., Proc. Natl. Acad. Sci. U.S.A. 114, E5444 (2017).Abstract/FREE Full TextGoogle Scholar W. Yan et al., Int. J. Biochem. Cell Biol. 38, 1417 (2006).CrossRefPubMedWeb of ScienceGoogle Scholar C. Amici et al., Antivir. Ther. 11, 1021 (2006).PubMedWeb of ScienceGoogle Scholar W. J. Sander et al., Front. Physiol. 8, 89 (2017).CrossRefPubMedGoogle Scholar K. Schaeuble et al., PLOS Biol. 17, e3000072 (2019).CrossRefPubMedGoogle Scholar Y. Cao et al., Cell Discov. 6, 11 (2020).CrossRefPubMedGoogle Scholar T. Grosser et al., J. Clin. Invest. 116, 4 (2006).CrossRefPubMedWeb of ScienceGoogle Scholar K. Wu, W. Li, G. Peng, F. Li, Proc. Natl. Acad. Sci. U.S.A. 106, 19970 (2009).Abstract/FREE Full TextGoogle Scholar L. Fang, G. Karakiulakis, M. Roth, Lancet Resp. Med. 10.1016/S2213-2600(20)30116-8 (2020).Google Scholar Source: science.sciencemag.org/content/367/6485/1434.1
|
